Poverty proofing Doncaster specialist epilepsy and Parkinson’s 2026

1 Poverty proofing delivery partner model

Children North East are working in partnership with Rotherham, Doncaster and South Humber (RDaSH) NHS Trust to fulfil its ambitious promise to “poverty proof” all of its services by December 2025. The trust has committed to piloting a bespoke Delivery Partner Model developed in partnership with Children North East (CNE).

Poverty Proofing is a nationally recognised tool, designed to educate and enable health care professionals to identify, acknowledge, and reduce the impact of poverty, advocating for equality of access to healthcare, services and technologies that contribute to overall health outcomes experienced by those living in poverty.

A locally trained team (LTT) of people have been trained and are being supported by Children North East to carry out this work in line with the ethos and principles of Poverty Proofing.

• Phase 1: 3 model audits carried out by Children North East.
• Phase 2: a further 6 audits carried out by the locally trained team with support from Children North East.
• Phase 3: all other trust services will engage in the Poverty Proofing process during 2025 and 2026. Children North East will deliver training to all staff; the locally trained team will carry out scoping of services and engage patients and staff in consultations; and the trust strategy team members will deliver feedback and write reports for each service. Moving forward, services will become more poverty informed, learning how to work with their patients to identify barriers, so that poverty becomes everyone’s business, and no-one is left out or left behind.

This whole system approach is unique and has accountability at every level and a commitment to alleviate barriers that apply across the whole system.

2 Poverty proofing Doncaster specialist epilepsy and Parkinson’s

The poverty proofing audit for Doncaster specialist epilepsy and Parkinson’s service began in October 2025 to better understand the experiences of families and individuals who are living in poverty.

The work was carried out in partnership with staff, families and adults to build up a rich picture of the barriers and challenges faced by those accessing the Doncaster specialist epilepsy and Parkinson’s service.

The epilepsy specialist nursing service operates throughout the Doncaster borough, collaborating with neurologists, GPs, private, and public voluntary sectors to aid patients with epilepsy across primary, secondary, and tertiary care in managing their condition.

The service supports consultant neurology clinics, conduct nurse-led clinics, work within the community, and provide a phone clinic or support service.

The service assist adults residing in Doncaster with a Doncaster GP and offer visits within the borough’s boundaries. Patients outside these boundaries need to attend a local clinic in Doncaster.

The Parkinson’s disease specialist nursing service offers diverse support for individuals diagnosed with Parkinson’s disease. The team comprises nurses, occupational therapists, physiotherapists, and rehabilitation assistants.

The service collaborates closely with various healthcare professionals, extending a range of services:

• nurse-led clinical consultations available via phone, WhatsApp, Microsoft Teams, local clinics, or at the Evergreen Clinic
• home visits for housebound individuals or those residing in care homes
• active group sessions focusing on promoting a healthy lifestyle through exercises, relaxation techniques, and educational sessions
• assessments for equipment and strategies aiding in independent daily activities
• provision of advice, support, and education

According to the Indices of Multiple Deprivation 2019, Doncaster is ranked 48th most income-deprived out of 316 local authorities. Of the 194 neighbourhoods in Doncaster, 68 were among the 20% most income-deprived in England.

In research by the Joseph Rowntree Foundation and King’s Fund:

“The authors describe how patients may struggle to access NHS diagnosis and treatment due to issues such as the cost of travelling, difficulties accessing online services, and paying for NHS charges. They also note that the stigma of poverty can lead to a reluctance to come forward for treatment, or to seek help more broadly, for example by accessing financial advice. Additionally, administrative processes, such as claiming back travel expenses, can be complex.”

3 Poverty proofing ethos

No activity or planned activity should identify, exclude, treat differently or make assumptions about those whose household income or resources are lower than others.

3.1 Voice

The voice of those affected by poverty is central to understanding and overcoming the barriers that they face.

3.2 Place

We recognise that poverty impacts places differently, and so understanding place is vital in our response. Organisationally we also need to be clear about why and how decisions are made. This understanding of context is essential.

3.3 Structural inequalities

The root causes of poverty are structural. What structural changes can we make at an organisational level to eliminate the barriers that those in poverty may face?

4 Poverty proofing process

4.1 Stage 1: training and consultation with staff

8 staff completed a three-hour training session.

4.2 Stage 2: scoping

Time was spent gathering information about the setting and how it works. This stage included conversations with staff and management, observing interactions and reviewing key areas such as the website and communications.

4.3 Stage 3: patient and community consultations

We spoke to 4 people who use the service, and 39 others completed a survey (including Easy Read versions). We spoke to 2 staff who work in the service, and 9 staff competed a survey.

4.4 Stage 4: feedback session

A draft of the findings was shared with Jayne Brocklehurst prior to publication. We will discuss our findings and collaboratively consider various changes that could be implemented at the Poverty Proofing Community of Practice Group.

4.5 Stage 5: review

Around 12 months after completion, the trust will complete a review, identifying impact, good practice and potential considerations moving forward.

5 Common themes

The next sections of this report highlight the most common themes to come out of the poverty proofing consultations. For each theme the report covers:

• what works, what you do now that supports those experiencing poverty
• the barriers and challenges faced by those experiencing poverty
• recommendations, each recommendation comes with a set of considerations for “poverty proofing” the service

The themes are presented alphabetically, and this does not imply any hierarchy of importance. The themes for Doncaster specialist epilepsy and Parkinson’s were:

• communication
• health-related costs
• navigating and negotiating appointments
• patient empowerment
• staff awareness and guidance
• travel

5.1 Communication

Communication is important to consider in Poverty Proofing both from a health literacy perspective of how information is communicated and understood and in ensuring there are reciprocal lines of communication between services and service users. O’Dowd (2020) reported that availability of care was a particular concern for those on a low income and there were significant inequalities in care availability for the most deprived areas. Communication is a key factor in ensuring availability of care.

5.1.1 What works

5.1.1.1 The service is welcoming

The majority of people told us that they felt that the service is welcoming. Those that did not, said it was because they were experiencing an illness or that they were new to the service. This is also supported by the positive feedback both the Parkinson’s and specialist epilepsy services get on Care Opinion.

“Everyone is always very friendly and supportive.”

“Always been very supportive of me and my fiancée who cares for me.”

“The receptionist is wonderful; she told me where to get a drink while I am waiting for my friend.”

5.1.2 Barriers and challenges

5.1.2.1 Information in reception areas

People told us that there could be better information in reception areas when they visit for an appointment themselves or are accompanying someone else.

“It’s great that there are leaflets available but for the past 6 months I have been coming here there has been limited information on Parkinson’s that I have found useful to help me support my husband.”

“I bring my father for his appointments and if I didn’t have my phone, I’d be bored stiff, could there not be a TV installed even just to give information of services available within the trust.”

“I once wanted to raise a concern, but there was no visible information to tell me how to do this. I ended up telling my clinician, but it wouldn’t have been an issue that they could resolve.”

5.1.2.2 Signage in reception areas

People made suggestions in how signage when they come in for appointments could be improved that would make their experience better.

“I know I have come for a Parkinson’s appointment, but it would be great to read the name on the door to which clinician I walk into like they do at GP surgeries.”

“There are a few clinics that run in this space and while the reception staff is lovely and friendly. Sometimes the space is unmanned and if you come for the first time there isn’t any signage that notifies which clinics are in session in that space so it would be great if there was something that shows that Parkinson, epilepsy, falls clinics are in session and to wait in the waiting area.”

5.1.2.3 The language we use may mean some people don’t understand what is being asked of them, or is available

A number of staff said that the way we communicate with people might be a barrier to them understanding what is on offer to mitigate poverty. It is important to understand a person’s communication needs and ability, so they know what available and what treatment they will receive. People also told us that better communication and outreach would be a good thing to introduce.

5.1.3 Recommendations for communication

5.1.3.1 Information in reception areas

Over a period of time, talk to people when they come in to see what information would be good to share in reception. This could be collated by volunteers the service has recruited.

5.1.3.2 Signage in reception areas

• Ask a group of peers or patient group to have a “walk through” a reception area to identify possible areas that could be improved. Then, make changes based upon the feedback.

5.1.3.3 Communicating with people based upon their needs and ability

• Make sure people are asked about their communication needs and preferences, and this is recorded on SystmOne.
• Make sure communication needs and preferences are recorded in SystmOne.
• Check with people that they understand what is being communicated to them. Get them to explain what is being said.

5.2 Health related costs

“Money buys goods and services that improve health; the more money families have, the more or better goods they can buy.” (Joseph Rowntree Foundation, How does money influence health? 2014).

The Food Foundation (2023) found that in order for the poorest fifth of the population in the UK to meet the Government recommended healthy diet guidance they would need to spend half of their disposable income, compared to just 11% for the least deprived fifth.

5.2.1 Barriers and challenges

People might not feel confident in talking to staff about money
Some people told us the service asked them to pay for items they do not necessarily provide like walking aids, eating and drinking equipment. What isn’t clear is if the person has been asked if they have the money to pay for such items. This may mean people either don’t buy them or go without something else. Most people were not sure if the service would offer advice on other services who may be able to support. We were also told by people that they disagreed that costs were affordable. They also said it would be good to provide information on support available for equipment. Staff also told us the time taken to do assessments may mean asking about other income matters may be missed.

“Extra pain meds and aids.”

“I don’t like talking to people about my money worries.”

5.2.1.1 Cost of prescriptions

There are some instances where people will be entitled to free prescriptions. It may be that these people are entitled to Universal Credit or another benefit and should be referred to Citizens Advice for a money check. People told us that help with the cost of prescriptions would be a good thing to introduce.

5.2.2 Recommendations for health related costs

5.2.2.1 See if people are entitled to help with prescription costs

• Advise patients about the HC2 form and how to fill it in effectively.
  Advise that patients who are paying for prescriptions whilst their HC2 form is being processed, should keep their receipts to be reimbursed.
• See if people are entitled to financial support.
• Make all staff aware that the NHS Travel Costs Scheme exists. Provide clear information on who can apply and what they are entitled to claim for (this may not only be people who are on benefits, others can be eligible through the NHS Low Income and Healthcare Travel Costs Schemes).
• Refer people to Citizens Advice Doncaster to see if they are entitled to support with transport or other costs and other benefits (link at the end of this report).

5.3 Navigating and negotiating appointments

Life can be particularly unpredictable when living on a low income. The challenges, for example around childcare or zero hours’ contracts can make attending appointments very difficult. Pressures on the NHS around waiting times and stretched services can mean there is little scope for flexibility and strict discharge policies are applied for those who miss appointments, effectively severing access for those with changeable circumstances. Furthermore, social problems often accompany poverty, and sometimes life can be chaotic, which makes consistent appointment attendance difficult. Availability and flexibility of care are important for improving access to health care for those on a low income.

The King’s Fund (2021) report states that:

“Services need to be flexible, accessible, responsive and offer continuity of care.”

5.3.1 What works

5.3.1.1 People value the flexibility to have home or clinic appointments

We asked people whether they preferred home or clinic appointments: some people said they prefer a home visit or clinic, the majority told us they prefer both options. The comments made by people show the different reasons this flexibility is valued. Staff also told us if someone has told the service that affordability is an issue to attend appointments, they will try and arrange a home visit.

“Saves on taxi costs.”

“It’s easier for planning to have someone come and see me than me coming over.”

“A chance to go out.”

“I bring my dad for his appointments and sometimes I’m not available so it’s good to have the options.”

“Sometimes I cannot get out so it’s great to have an option to be visited at home.”

“If I have no access to patient transport sometimes it’s better to be visited at home.”

5.3.2 Barriers and challenges

5.3.2.1 Parking for people with limited mobility

We were told that for people with limited mobility, parking near to where the clinic is, can be difficult.

“I’m grateful that parking is free but it’s sometime a struggle especially when you bring a loved one with limited mobility and must drop them off and then drive around looking for parking. If the parking space behind evergreen was designated for patient coming there it would be great with some disabled spaces marked as well.”

5.3.2.2 Carer availability to support to attend appointment

We were told by people that sometimes the timing of appointments was both difficult for carers and mean they lose out on earning money. Staff also told us that people do rely a lot relying on family members for appointments, for example, bringing parents to appointment and needing to get childcare (costing the family member). Staff said they need to think about appointments in school holidays, weekend appointments.

“I cannot drive because of my epilepsy, and my family members are quite busy most of the time so it’s difficult to get to appointments sometimes.”

“My fiancée sometimes has to have time off work to come to appointments with me. This is due my increased anxiety of what would happen if I had a seizure in a public space. She doesn’t always get paid for these so some appointments we have to reschedule.”

5.3.2.3 Size of clinic space

We were told by staff that clinic space in Evergreen for seeing people may not be big enough.

“It’s great to have the clinic spaces that we have in evergreen but sometimes they are not large enough especially when you are looking after wheelchair users. I had a patient say that they felt claustrophobic.”

5.3.2.4 Complexity of health systems

A number of staff said that the health system itself can make it difficult for people to get the support and treatment they are entitled to. Not only does this mean it can delay a person’s treatment, but it can also mean prevents people from accessing other healthcare.

5.3.2.5 Hidden costs of accessing services

Staff told us that there were indirect costs to people, such as childcare or time off work, that could make attending appointments difficult.

5.3.2.6 Requesting home appointments

We were told by staff that a barrier to people asking for or requesting home appointments are the questions people need to answer for this to be decided. These questions are about mobility, not affordability.

“Making home visits easier for patients to access. Admin staff not having to ask awkward questions such as ‘Do you leave your house to go shopping’.”

5.3.3 Recommendations for navigating and negotiating appointments

5.3.3.1 Help create simpler health systems

• Identify on the patient pathway where people come into contact with other health and care services.
• Look to work with those organisations to make the process as simple as possible.
• Make sure people understand what the steps are, either being taken by the service or that they need to do themselves.
• Access peer support for the person to help them navigate the system where it is needed.

5.3.3.2 Home visits

• Consider offering home appointments to people identified as being on low-income or with increased health risk, where this isn’t currently offered.
• Consider offering home appointments where possible, especially during the initial period of accessing the service. This could allow people to feel more comfortable and open up more than in a clinical setting.

5.3.3.3 Appointment times

• Consider if appointment times are meeting the needs of the whole family and if there are any caring responsibilities that create a barrier to accessing appointments.
• Identify which appointment times are suitable with patients during assessments or treatment sessions.
• Explore the possibility of providing more out of hours appointments so that those with zero hours contracts or the self-employed have more choice when booking appointments reducing the potential loss of earnings.

5.3.3.4 Parking near Evergreen

Work with Estates to see if parking spaces near Evergreen could become for use by those with a disability.

Page last reviewed: February 10, 2026
Next review due: February 10, 2027

Problem with this page?

Please tell us about any problems you have found with this web page.

Do not include personal or medical information in your message. For example, NHS number, date of birth or medical history.

Type of problem -- Please choose an option -- Wrong information Accessibility Spelling or grammar Layout or display Other

Please provide details of the problem

If you would like us to contact you about your issue, please enter your contact information below.

Your name (optional)

Your email address (optional)

Your phone number (optional)